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Co-morbidities

This page will be dedicated to addressing the co-occurrence of other psychiatric conditions with addiction and addictive behaviours.

For example, conditions such as post traumatic stress disorder and generalized anxiety disorder and major depression are said to frequently co-occur with addictive disorders.

This page will be addressing how frequently these disorders actually co-occur with addiction, or whether their influence has been overstated.

How they should be treated, whether treatment for addiction can help with these disorders too or whether they should be treated separately and importantly whether these so-called co-morbid conditions are tributaries which feed into the overall disorder of addiction?

In other words, when we receive treatment specifically for addictive behaviours are we also treating the conditions which have canalized into addiction.

If so does medication help or hinder sobriety and recovery, especially if prescribed based on a misdiagnosis of addictive disorder showing as an affective disorder?

When considering relapse prevention, are we addressing behaviours and responses to negative emotions and stress reactivity which are common to all affective disorders?

Do these conditions all contribute to addiction severity?

Do they contribute to similar hyper amgydaloid reactivity, to the same cognitive distortions, to similar “fight of flight” responding, to common recruitment of more motoric parts of the brain when making decisions, to similar rumination, in effect to a similar profile of emotion dysregulation?

Do they all have common neurotransmitter deficits, similar dysregulated stress systems and reward networks?

Is addiction a unitary disorder whereby negative affect leads to an impulsive, urgent desire to regulate these emotions by external means such as substances and behaviours, whereas other affective disorders do not have this behavioural manifestation?

Is negative urgency a trait that distinguishes between addictive behaviour and other affective or psychiatric disorders?

These questions seem very pertinent in trying to understand if addiction is in fact a unitary disorder in it’s own right or whether it is a unitary disorder also affected by co-morbidity?

Are so-called co-morbidities really co-morbidities or are they substance induced disorders which dissipate in the early weeks of recovery?

Do they manifest as anxiety and depression in active addiction but disappear when a neuro-toxic substance is eliminated from one’s nervous system?

Or perhaps we continue to have anxiety type issues in recovery but do not appreciate this because we are managing these issues with 12 step recovery?

One way or the other, surely addiction is more than use of substance of behaviour despite negative consequences. Surely it is more than simply reducible to use of substance or behaviour alone?

If addiction is a unitary disorder how come we appear to share common distorted thinking and maladaptive behaviours as a range of other affective disorders?

Do the vast majority of us have various affective disorders which lead to chronic reliance on substances or behaviours?

Or is addiction a unitary disorder in it’s own right? A disorder neuro science and psychology knows little about – so little they relegate all it’s emotion dysfunction to that of co-morbidity?

The answers to these questions seem more urgent now than ever before?

In this page we will attempt to answer some of these questions.

We will address the reality that addiction shares a multitude of cognitive distortions and maladaptive responses and behaviours with other affective disorders.

Why is this? Are these disorders different and how so?

Are there similar underlying neuro-mechanisms with all these disorders?

What it is about addiction that sets it out as a disorder separate from all other disorders?

For example, we believe addiction has a distress based impulsivity at its core which is based on a lack of emotion clarity and differentiation which results in risky (impulsive) maladaptive decision making. This appears to differentiate addiction from other affective disorders?

This makes addiction a disorder of “just one more…that’s all I need” – it is an affective disorder which results in a motivation to alter feelings via external means.

One may also be able to use certain scales such the Difficulties in Emotion Regulation DERS scale which appears to be able to differentiate between different disorders.

Ultimately, are all these disorders similar in their emotion dysregulation but not in the manifestation of this emotion dysregulation in terms of manifest behaviour?

Have we been diagnosing some affective disorders for years when they are often addictive disorders in disguise?

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I am a recovering alcoholic/addict, researcher into the neuropsychology of addictive behaviours, writer and blogger at http://alcoholicsguidetoalcoholism.com/
and https://insidethealcoholicbrain.com/
and have contributed to various other addiction/recovery-based websites such as Addictionland, Klen + Sobr and Recovery SI.
I currently research and write theoretical articles with academics from a UK University